Traumatic cervical instability associated with cord oedema and temporary quadriparesis

Abstract

Study design: A case report of blunt cervical spine trauma associated with cord oedema at the C3/C4 level with temporary Frankel/American Spinal Injury Association Grade A quadriparesis and motion segment instability without evidence of associated bony lesions (spinal cord injury without radiological abnormality, SCIWORA lesion). Objectives: By means of a rare and illustrative case, the reader's attention is focused on eventual marked cervical motion segment instability in SCIWORA patients. Setting: A department of Neurology in Quito, Ecuador and a department of Neurosurgery in Bern, Switzerland. Method: A 73-year-old man sustained blunt cervical spine trauma. After resolution of paraparesis, dynamic studies of the cervical spine revealed translational instability of C3 over C4. The patient underwent segment fusion by intervertebral cage insertion and plate fixation. Results: The patient had recovered almost completely from tetraparesis under conservative treatment. The postoperative course was uneventful. Solid bony fusion of the C3/C4 motion segment was obtained. Conclusion: Despite normal cervical alignment, the lack of bony lesions and neurological recovery, magnetic resonance imaging and dynamic studies may reveal marked translational cervical motion segment instability requiring segment fusion in order to prevent ongoing damage of the spinal cord.

Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study

“…In addition, according to Ning's report [13], the total number of adult SCIs in Tianjin was 869 from 2004 to 2008. In our series, compared with other studies [22], the incidence rate of SCIs was about 5.74% per million population from 2004 to 2008. An increasing incidence of adult SCIWORAs in Tianjin was evident during the last 5 years.…”

Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation

“…Traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation often is described as CSCI without radiographic abnormality (SCIWORA) [1][2][3] or CSCI without radiologic evidence of trauma (SCIWORET) [4][5][6]. Most patients are elderly and have radiographic abnormalities such as osteophytes, disc bulging/herniation, hypertrophy of the ligamentum flavum, or ossification of the posterior longitudinal ligament, and may present with tetraplegia caused by hyperextension injury, predominantly at the C3-4 segment, with cord compression as a result of a stenotic spondylotic canal [1,5,[7][8][9].…”

Predictores en el cuadro SCIWORA del adulto

“…Those over this age with partial neurological compromise, and who were treated surgically before 10 days, showed neurological improvement, as did those who underwent surgery 18 months after the trauma, with improvement of at least one level on the ASIA scale, and five points on the JAO scale. (Tables 3 and 4) DISCUSSION Some authors affirm that degenerative changes or calcification of the posterior common vertebral ligament produce excessive traction of the spinal cord during the accident and can influence the development of SCIWORA; 34 while others deny this relationship, and believe these changes have no direct influence on the presence of neurological impairment following low-energy trauma. 35 For the diagnosis, MRI is considered the method of choice 15,36 but when this is not conclusive; diffusion MRI or proton emission tomography (PET) may be useful in those patients with negative MRI and with myelopathic neurological syndrome.…”